Quality Auditor

3 hours ago


Ayala Alabang, National Capital Region, Philippines Coforge Full time

Role
:
Quality Auditor (RCM - Blended)

Experience
: 3–6 years of hands-on RCM experience with strong understanding of multiple RCM domains & minimum 1–2 years in a quality/audit role preferred

Skills
: Solid knowledge of US healthcare RCM, payer rules, documentation standards, and audit methodologies

Location
: Muntinlupa, Philippines

We at Coforge are hiring
Quality Auditor (RCM - Blended)
with the following skillset:

  • Perform regular quality audits across assigned RCM work types with high accuracy and attention to detail.
  • Review documentation, charge entries, AR followup actions, eligibility verification details, and UM/UR determinations for correctness.
  • Identify errors, trends, and root causes; provide actionable feedback to operations teams.
  • Maintain quality dashboards, audit logs, and performance reports for internal and client review.
  • Collaborate with operations, training, and compliance teams to improve processes and reduce recurring defects.
  • Validate adherence to payer policies, coding guidelines, documentation standards, and HIPAA compliance.
  • Conduct calibration sessions and participate in refresher training to ensure uniform understanding of quality standards.
  • Support new hire quality audits and ongoing competency assessments.
  • Recommend process enhancements aimed at improving accuracy, efficiency, and audit scores.


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